Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
Circ Cardiovasc Imaging. 2012 Nov;5(6):765-75. doi: 10.1161/CIRCIMAGING.112.976654. Epub 2012 Aug 22.
Pulmonary hypertension (PH) has diverse causes with heterogeneous physiology compelling distinct management. Differentiating patients with primarily elevated pulmonary vascular resistance (PVR) from those with PH predominantly because of elevated left-sided filling pressure is critical.
We reviewed hemodynamics, echocardiography, and clinical data for 108 patients seen at a referral PH clinic with transthoracic echocardiogram and right heart catheterization within 1 year. We derived a simple echocardiographic prediction rule to allow hemodynamic differentiation of PH attributed to pulmonary vascular disease (PH(PVD), defined as pulmonary artery wedge pressure [PAWP]≤15 mm Hg and PVR>3 WU). Age averaged 61.3±14.8 years, μPAWP and PVR were 16.4±7.1 mm Hg and 6.3±4.0 WU, respectively, and 52 (48.1%) patients fulfilled PH(PVD) hemodynamic criteria. The derived prediction rule ranged from -2 to +2 with higher scores suggesting higher probability of PH(PVD): +1 point for left atrial anterior-posterior dimension <3.2 cm; +1 for presence of a mid systolic notch or acceleration time <80 ms; -1 for lateral mitral E:e'>10; -1 for left atrial anterior-posterior dimension >4.2 cm. PVR increased stepwise with score (for -2, 0, and +2, μPVR were 2.5, 4.5, and 8.1 WU, respectively), whereas the inverse was true for pulmonary artery wedge pressure (corresponding μPAWP were 21.5, 16.5, and 10.4 mm Hg). Among subjects with complete data, the score had an area under the curve (AUC) of 0.921 for PH(PVD). A score ≥0 had 100% sensitivity and 69.3% positive predictive value for PH(PVD), with 62.3% specificity. No patients with a negative score had PH(PVD). Patients with a negative score and acceleration time >100 ms had normal PVR (μPVR=1.8 WU, range=0.7-3.2 WU).
We present a simple echocardiographic prediction rule that accurately defines PH hemodynamics, facilitates improved screening and focused clinical investigation for PH diagnosis and management.
肺动脉高压（PH）有多种病因，其生理学表现也各不相同，需要不同的治疗方法。区分主要因肺血管阻力升高而导致的患者和主要因左心充盈压升高而导致的 PH 患者至关重要。
我们回顾了在转诊 PH 诊所就诊的 108 例患者的血流动力学、超声心动图和临床数据，这些患者在 1 年内接受了经胸超声心动图和右心导管检查。我们得出了一个简单的超声心动图预测规则，以允许根据肺血管疾病（PH(PVD)）导致的 PH 进行血流动力学区分，定义为肺小动脉楔压（PAWP）≤15mmHg 和肺血管阻力（PVR）>3 伍德单位。患者平均年龄为 61.3±14.8 岁，平均 μPAWP 和 PVR 分别为 16.4±7.1mmHg 和 6.3±4.0 伍德单位，52 例（48.1%）患者符合 PH(PVD)血流动力学标准。得出的预测规则范围为-2 至+2，得分越高提示 PH(PVD)的可能性越大：左心房前后径<3.2cm 得 1 分；存在中收缩切迹或加速度时间<80ms 得 1 分；外侧二尖瓣 E:e'>10 得-1 分；左心房前后径>4.2cm 得-1 分。随着得分的增加，PVR 呈阶梯式增加（-2、0 和+2 时，μPVR 分别为 2.5、4.5 和 8.1 伍德单位），而肺动脉楔压则相反（相应的 μPAWP 分别为 21.5、16.5 和 10.4mmHg）。在有完整数据的受试者中，该评分对 PH(PVD)的曲线下面积（AUC）为 0.921。得分≥0 时，PH(PVD)的敏感性为 100%，阳性预测值为 69.3%，特异性为 62.3%。没有得分阴性的患者患有 PH(PVD)。得分阴性且加速度时间>100ms 的患者的 PVR 正常（μPVR=1.8 伍德单位，范围=0.7-3.2 伍德单位）。
我们提出了一个简单的超声心动图预测规则，可以准确定义 PH 的血流动力学，有助于改善 PH 诊断和管理的筛查和有针对性的临床检查。
